The Acid Perfusion Test in Gastroesophageal Reflux Disease

Abstract

An acid perfusion test, isotope scanning, endoscopy, and esophageal biopsy were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. A positive acid perfusion test within 30 min (APT) and within 5 min (TAPT) was found in 70.2% and 37.6% of the patients, respectively. A positive APT was found significantly more often in patients with than without endoscopic esophagitis, whereas a positive TAPT was found significantly more often in patients with severe symptoms than in patients with moderate symptoms and in a significantly higher proportion of patients with than without GER by scintigraphy. Neither the APT nor the TAPT showed any dependency on the presence of histologic esophagitis. Most (97%) patients with a negative acid perfusion test, in addition to typical symptoms, also presented with scintigraphic, endoscopic, or histologic evidence of GER disease. Although it shows that the acid perfusion test, particularly when early positive, may serve as a weak predictor of the severity of GER disease, the present study gives little support to the test's clinical usefulness.

Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis

“…Therefore, our data may indirectly suggest less visceral perception in NERD patients by showing diminished sympathetic modulation in these patients. This notion is in line with a previous study by Kaul et al in which it was shown that NERD patients are less sensitive in comparison with patients with ERD [30].…”

Sensory Testing of the Esophagus

“…Although the basic principal of the test remained similar, many investigators have tried different acid perfusion rates, concentrations, and durations in the hope of increasing the sensitivity of the test. [27][28][29][30][31][32][33][34] Furthermore, some have even suggested the addition of bile salts to the acid solution. 35 Many attempts were made to change the test from a qualitative to a quantitative tool.…”

Role of saliva in esophageal function and disease

“…Although not widely appreciated, esophageal acid perfusion can elicit heartburn in a majority of healthy volunteers without a history of heartburn [40,41]. Heartburn evoked in volunteers, however, differs from that elicited in patients with esophagitis.…”

“…Most patients with reflux esophagitis experience reproduction of their heartburn upon perfusion of the esophagus with acid [39][40][41]. Although not widely appreciated, esophageal acid perfusion can elicit heartburn in a majority of healthy volunteers without a history of heartburn [40,41].…”